Reducing parenteral requirement in children with short bowel syndrome: impact of an amino acid-based complete infant formula.
BACKGROUND
The aim of this study was to assess the impact of an amino acid-based complete infant formula on enteral feeding tolerance and parenteral nutrition requirement in children with severe short bowel syndrome.


METHODS
Four children (23 months-4.75 years) with short bowel syndrome who required long-term parenteral nutrition due to persistent feeding intolerance while receiving an extensively hydrolyzed formula were assessed before and after the commencement of an amino acid-based complete infant formula for a mean follow-up period of 48 months (range 39-51 months). Assessment included clinical monitoring of feeding tolerance and nutritional status, biochemistry, stool analysis, skin-prick testing to common food antigens, esophagogastroduodenoscopy and colonoscopy or jejunoscopy with biopsies, and measurement of disaccharidase levels and intestinal permeability.


RESULTS
All patients ceased parenteral nutrition within 15 months as a result of decreased stool output and resolution of vomiting. Patients had a reduction in hospitalization (mean: 198 versus 98 days/patient/year), episodes of proven (mean: 4.3 versus 3.3/patient/year) and suspected (mean: 6.5 versus 4.0/ patient/year) bacterial sepsis and central line insertions (mean: 2.5 versus 1.5/patient/year). Intestinal permeability to lactulose fell markedly (mean: 69% versus 2.7%). Disaccharidase levels increased in all three patients undergoing repeat studies.


CONCLUSIONS
An amino acid-based complete infant formula improved feeding tolerance and eliminated the need for parenteral nutrition in four children with short bowel syndrome who had previously required long-term parenteral nutrition. The clinical improvement was mirrored by improvement in measurements of intestinal function.
Bines
J
J
Department of Gastroenterology and Clinical Nutrition, Royal Children's Hospital, Victoria, Australia.
Francis
D
D
Hill
D
D
D000138:Acidosis; D000596:Amino Acids / Q000008:administration & dosage*; D002675:Child, Preschool; D002149:Energy Intake; D004750:Enteral Nutrition; D005243:Feces; D005260:Female; D006801:Humans; D007223:Infant; D007225:Infant Food; D007413:Intestinal Mucosa / Q000378:metabolism; D007582:Jejunostomy; D007792:Lactulose / Q000378:metabolism; D008297:Male; D010288:Parenteral Nutrition / Q000009:adverse effects; D012778:Short Bowel Syndrome / Q000151:congenital / Q000628:therapy*; D013997:Time Factors; D014839:Vomiting; D015430:Weight Gain
D000596:Amino Acids; D007792:Lactulose